Spiritual Distress (Distress of Human Spirit)

 

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. When you click on Next at the bottom of the page, you see the data you submitted. Please follow the instructions on how to save the data on the next page.

AOL users: Read this instruction.

Definition:state in which the individual experiences a disturbance in the belief or value system which provides strength, hope, and meaning to life.

1. Your initials (required): 

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis  questions credibility of belief system demonstrates discouragement or despair
unable to practice usual religious rituals questions meaning of own existence seeks spiritual assistance
verbalizes concern about relationship with deity
3. Related Factors- check those that apply to your client:

separation from religious or cultural ties terminal illness debilitating disease trauma death or illness of significant other
childbirth abortion surgery blood transfusion


4. Goal (ultimate, long term) 

5. Outcome Criteria (short term) 

6. Evaluation: Was the outcome criteria met? 

Yes- Give Evidence: 

No- Explain how you would change the plan: 

7A. Interventions 
1. 

2.

3. 

4. 

5.

6. 

7B. Rationale for each intervention
1. 

2. 

3. 

4. 

5. 

6. 
 
 

 
 
Back to top
Return to Care Plan Homepage